12-Pound Tumor Swallows Man's Face

Jose Mestre's face was consumed by a 12-pound tumor, an explosive growth of blood vessels that blinded him in one eye and invaded his mouth, making it difficult to breathe and nearly impossible to eat.

Doctors in his native Portugal had given up hope that they could operate on the 53-year-old former traffic guard, and Mestre had resigned himself to the fact that he surely would die.

But thanks to the intervention of a stranger, who had watched a plastic surgeon perform miracles on another patient with a facial tumor on a Discovery Health documentary, now Mestre is on the road to recovery.

"It's an incredible story," said McKinnon, who specializes in craniofacial surgery. "I have not seen a facial tumor quite as dramatic as this ever… His face was a mass of fiber and tumor and blood vessels that made him unrecognizable as a human being."

Mestre had been born with a venous malformation, also called a hemangioma, one that had begun growing uncontrollably at the age of 14. These tumors typically increase in size during puberty and his had begun to distort all of his facial features.

Eating was difficult, causing bleeding on his tongue and gingiva, and Mestre's left eye was completely destroyed as the tumor literally swallowed his face.

"For all of his adult life his face had shocked those around him and made his life a kind of living hell," said McKinnon. "His mother sought medical advice in their country, Portugal, and at multiple other medical centers in Spain, Germany and England. They were given conflicting diagnoses and plans of treatment."

Helping Jose was complicated by the fact that his mother was a Jehovah's Witness -- a religious denomination that bans blood transfusions -- and she wanted her son to follow her faith.

"Jose would eventually be forced to decide between death from complications of frequent bleeding from the growing tumor, or renouncing his faith and receiving definitive surgery," he said.

But three years ago, Mestre's mother died and his younger sister Edith, a hairdresser in her late 40s, became his guardian and became more proactive in seeking medical care.

British Tourist Saves Man With Facial Tumor

Mestre's fate changed when an English tourist, who had watched documentaries about facial surgery at St. Joseph, saw him on the streets of Lisbon. That stranger, known to doctors only as "Peter," arranged an introduction by e-mail to McKinnon who examined Mestre while giving a medical presentation in Portugal in 2008.

"Jose and his sister speak of him with such reverence," said hospital spokesman Margo Schafer. "They call him 'our angel Peter.'"

Since then, doctors have had no contact with the tourist.

In 2010, after much "prodding" by his sister, Mestre arrived in Chicago for surgery.

"It got to the point that the tumor was so life-threatening that Edith had really pushed him to have surgery," said Schafer. "She told him, 'You are going to die anyway, so die trying.' He was really strong in what he was going through."

Even the government of Portugal got involved, paying Mestre's medical expenses under its national healthcare system, she said.

McKinnon explained early on to Mestre and his sister the pros and cons of a facial transplant versus standard surgery.

"Standard surgery done by experienced craniomaxillofacial surgeons is still the preferred pathway to success," he said. "There are very serious risks of allotransplantation that may not be fully appreciated by the public."

The risks include acute and/or chronic rejection; need for permanent immunosuppression of the immune system; death by infection; and higher risk of malignancy.

Also, notes McKinnon, the medical alternatives to transplant failure are still not addressed.

"They cannot go on heart assist with a device, they can't receive another face transplant in all likelihood, and they can't go on renal dialysis, the alternative for kidney transplant failures, " he said.

At his recommendation, the Mestres decided to go ahead with surgery.

McKinnon and his colleagues performed three procedures over the course of three months. The first, done in July, entailed a tracheostomy to give Mestre a protected airway and removed 98 percent of the tumor.

In the second surgery, doctors took out a small residual portion of the tumor and began reconstruction of his mouth and nose. An additional tumor on his tongue was also removed.

In a third procedure, doctors fed a nasal gastric tube into Mestre to maintain proper nutrition. They repaired skin tissue that had broken down after the two previous surgeries.

"The skin had good arterial input, but the venus return was inadequate," said McKinnon.

Although Mestre's facial skin looks raw, McKinnon said, "it takes a lot of time to resume color, texture and shape."

Doctors hope that he will be able to have additional reconstructive surgery in Portugal, where Mestre and his sister returned in the fall.

"They didn't want to be here indefinitely," said McKinnon. "She had to make a living and run the hairdressing shop. It was time for them to get back."

Jose Mestre's Tumor Will Not Grow Back

Today, Mestre's post-operative face looks much like a burn victim.
Nevertheless his life "has really changed," according to Schafer.

"He never wanted to leave the house, but now he goes outside every day, singing," she said. "It's really remarkable and Dr. McKinnon is a remarkable surgeon."

Although McKinnon deems surgery a success, Jose has a long road ahead, especially psychologically.

"Despite how hard it may be for some people to understand, anyone who has lived with something like this for 40 years has a hard time letting go of it," he said. "And what the future holds can be more anxiety provoking. He had been very anxious about surviving the surgery and had been told by his doctors he would die. It was a wrenching experience for him."

Still, McKinnon said the tumor is not likely to grow back and Mestre's future holds promise. He may need minor surgery to his gums or tongue, but he is not longer in danger of losing his life.

"They are pretty sky-high right now," he said of the Mestres. "He needs more psychological recovery, but I have done what I can to guide them. Inevitably this is not something that one recovers from in a matter of months. It may take years to make a full recovery.

"But right now, he is elated to go out and not be the subject of undo attention or scorn."